Vitrectomy probe with adjustable cutter port size

ABSTRACT

Vitrectomy probes and system related thereto are disclosed herein. The disclosure describes various example vitrectomy probes having an adjustable cutting port size. Various example features are described for adjusting the size of the cutting port. Further, the disclosure provides examples for adjusting the size of the cutter port while the vitrectomy probe is in operation.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of prior application Ser.No. 13/219,017, filed Aug. 26, 2011, which is a continuation of priorapplication Ser. No. 12/974,722, filed Dec. 21, 2010, the entirecontents of both being incorporated herein by reference. Thisapplication also relates to application Ser. No. 12/974,740, filed Dec.21, 2010; application Ser. No. 13/219,089, filed Aug. 26, 2011;application Ser. No. 13/218,923, filed Aug. 26, 2011; and applicationSer. No. 13/218,826, filed Aug. 26, 2011.

TECHNICAL FIELD

The present disclosure relates to an ophthalmic microsurgicalinstrument. Particularly, the present disclosure is directed to avitreoretinal surgical instrument, e.g., a vitrectomy probe, having auser-selectable cutter port size.

BACKGROUND

Vitrectomy probes are used during vitreoretinal surgery to remove oculartissues, such as vitreous humor and membranes covering the retina. Theseprobes have a port for drawing in and dissecting tissues. The port opensa fixed amount, tissue is drawn into the port, the port closes, severingthe tissue, and the tissue is aspirated. This action may be repeated toremove desired tissues.

SUMMARY

According to one aspect, the disclosure describes a control system foroperating a vitrectomy probe and controlling a port size of thevitrectomy probe. The control system may include an output valve, afirst output port operable to communicate pneumatic pressure to thevitrectomy probe, a second output port operable to communicate pneumaticpressure to the vitrectomy probe, a first conduit coupled to the outputvalve and operable to communicate pneumatic pressure to the outputvalve, a venting control valve, a second conduit extending between theoutput valve and the venting control valve operable to conduct pneumaticpressure from the output valve to the venting control valve, a firstoutlet coupled to the venting control valve and open to the atmosphere,and a controller. The first output port may be coupled to the outputvalve, and the second output port may be coupled to the output valve.The controller may be operable to oscillate the output valve between afirst position in which the first conduit is in communication with thefirst output port and the second conduit is in communication with thesecond outlet port, and a second position in which the first conduit isin communication with the second output port and the first output portis in communication with the second conduit, the output valve maintainedat the first position and the second position for a selected timeperiod; move the venting control valve from a first position in whichthe second conduit communicates at a first amount with the second outletand a second position in which the second conduit communicates a secondamount with the second outlet when the output valve is in one of thefirst position or second position; maintain the venting control valve inthe second position for a first period of time less than the selectedperiod of time when the output valve is in one of the first position orsecond position to define the port size of the vitrectomy probe; andmove the exhaust control valve from the first position to the secondposition after the first period of time has elapsed.

Another aspect is directed to a system for performing a vitrectomy. Thesystem may include a vitrectomy probe and a control system. Thevitrectomy probe may include a first inlet port operable to conductpneumatic pressure to an oscillator, a second inlet port operable toconduct pneumatic pressure to the oscillator, and a cutter. The cuttermay include a first portion and a second portion. The oscillator may beoperable to reciprocate the first portion relative to the secondportion, and an amount of movement of the first portion relative to thesecond portion defines a port size of the cutter. The oscillator may beoperable to reciprocate at least a portion of the cutter. The controlsystem may include an output valve, a first output port operable toprovide communication between the first inlet port of the vitrectomyprobe and the output valve, a second output port operable to providecommunication between the second inlet port of the vitrectomy probe andthe output valve, a first conduit coupled to the output valve andoperable to provide communication with the output valve, a ventingcontrol valve, a second conduit extending between the output valve andthe venting control valve operable to conduct pneumatic pressure fromthe output valve to the venting control valve, a first outlet coupled tothe venting control valve and open to the atmosphere, and a controller.

The venting control valve may be operable to selectively vent pneumaticpressure from the second conduit to the atmosphere. The controller maybe operable to oscillate the output valve between a first position inwhich pneumatic pressure is communicated from the first conduit to thefirst output port and pneumatic pressure is communicated from the secondoutput port to the second conduit, and a second position in whichpneumatic pressure is communicated from the first conduit to the secondoutput port and pneumatic pressure is communicated from the first outputport to the second conduit, the output valve maintained at the firstposition and the second position for a selected time period; and movethe venting control valve between a first position in which a firstamount of pneumatic pressure from the second conduit is vented to theatmosphere through the first outlet and a second position in which asecond amount of pneumatic pressure is vented to the atmosphere throughthe first outlet. The controller may be operable to maintain the exhaustcontrol valve at the first position for a first period of time less thanthe selected period of time when the output valve is in the secondposition and move the exhaust control valve from the first position tothe second position after the first period of time has elapsed to definethe port size of the vitrectomy probe.

The various aspects may include one or more of the following features.The first amount of communication may be greater than the second amountof communication. The venting control valve may be an on/off valve, andthe first amount of communication between the second conduit and thesecond outlet when the venting control valve is in the first positionmay be a full amount of communication between the second conduit and thesecond outlet. The second amount of communication between the secondconduit and the second outlet when the venting control valve is in thesecond position may be no communication between the second conduit andthe second outlet.

The venting control valve may be a proportional valve, and the firstamount of communication may be greater than the second amount ofcommunication. The venting control valve may be a proportional valve.The first amount of communication provided between the second conduitand the second outlet when the venting control valve is in the firstposition may be a first variable amount of communication, and the secondamount of communication provided between the second conduit and thesecond outlet when the venting control valve is in the second positionmay be a second variable amount of communication between the secondconduit and the second outlet. The first variable amount may bedifferent than the second variable amount. An isolation valve may alsobe included, and the first conduit may extend between the isolationvalve and the output valve. An inlet conduit may be coupled to theisolation valve and may be operable to communicate pneumatic pressure tothe isolation valve. A second outlet may be coupled to the isolationvalve and may be open to the atmosphere. The controller may also beoperable to move the isolation valve between a first position in whichthe inlet conduit is in communication with the second outlet to ventpneumatic pressure in the first outlet conduit to the atmosphere and asecond position in which the inlet conduit is in communication with thefirst conduit to conduct pneumatic pressure to the output valve.

A first pressure sensor and a second pressure sensor may also beincluded. The first pressure sensor may be coupled to the first outputport, and a second pressure sensor coupled to the second output port.The controller may also be operable to receive a first signal from thefirst pressure sensor corresponding to pneumatic pressure at the firstoutput port and a second signal from the second pressure sensorcorresponding to pneumatic pressure at the second output port. Thecontroller may also be operable to move the isolation valve to the firstposition if the first pressure signal or the second pressure signal isoutside of a selected range.

The various aspects may also include one or more of the followingfeatures. The first amount of pneumatic pressure may be greater than thesecond amount of pneumatic pressure. The venting control valve may be anon/off valve. The first position of the venting control valve may be afully open position, and the second position of the venting controlvalve may be a fully closed position. The venting control valve may be aproportional valve. The first amount of pneumatic pressure vented to theatmosphere may be a first variable amount of communication, and thesecond amount of communication between the second conduit and the secondoutlet when the venting control valve is in the second position may be asecond variable amount of communication between the second conduit andthe second outlet. The first variable amount of communication may bedifferent than the second variable amount of communication. The firstvariable amount of communication may be greater than the second variableamount of communication.

The various aspects may also include one or more of the followingfeatures. The system may also include an isolation valve, an inletconduit coupled to the isolation valve and operable to communicatepneumatic pressure to the isolation valve, and a second outlet coupledto the isolation valve and open to the atmosphere. The first conduit mayextend between the isolation valve and the output valve. The controllermay be operable to move the isolation valve between a first position inwhich the inlet conduit is in communication with the second outlet tovent pneumatic pressure in the first outlet conduit to the atmosphereand a second position in which the inlet conduit is in communicationwith the first conduit to conduct pneumatic pressure to the outputvalve. The system may also include a first pressure sensor coupled tothe first output port and a second pressure sensor coupled to the secondoutput port. The controller may be operable to receive a first signalfrom the first pressure sensor corresponding to pneumatic pressure atthe first output port and a second signal from the second pressuresensor corresponding to pneumatic pressure at the second output port andmove the isolation valve to the first position if the first pressuresignal or the second pressure signal is outside of a selected range.

The details of one or more implementations of the present disclosure areset forth in the accompanying drawings and the description below. Otherfeatures, objects, and advantages will be apparent from the descriptionand drawings, and from the claims.

DESCRIPTION OF DRAWINGS

FIG. 1 shows an example surgical console.

FIG. 2 shows an example vitrectomy probe having a cutter with anadjustable-sized cutting port.

FIG. 3 shows a cross-sectional view of an eye in which a cutter of avitrectomy probe extends into a posterior segment of the eye.

FIGS. 4-8 are detailed cross-sectional views of a vitrectomy cuttershowing cutter ports with different sizes.

FIG. 9 shows a cross-sectional view of an example vitrectomy probehaving a user-controllable cutter port size adjustable with apiezoelectric motor.

FIG. 10 shows a cross-sectional view of an example vitrectomy probeincluding a shape memory alloy element for altering a size of thecutting port of the probe.

FIG. 11A shows a cross-sectional view of an example vitrectomy probeincluding a temperature control device and a fluid-filled enclosure foraltering a size of the cutting port of the probe.

FIG. 11B shows an example stroke limiter of the probe in FIG. 11A foradjusting the cutting port size.

FIG. 12 shows a cross-sectional view of another example vitrectomy probeoperable to adjust a size of the cutter port.

FIG. 13 shows a cross-sectional view of a further example vitrectomyprobe operable to adjust a size of the cutter port.

FIG. 14A is another cross-sectional view of the vitrectomy probe of FIG.13 showing a detail of an example stroke limiter.

FIG. 14B show a cross-sectional view of a detail of another examplestroke limiter.

FIG. 15 is a cross-sectional view of another example vitrectomy probeincluding another example stroke limiting device.

FIG. 16 is a further cross-sectional view of an example vitrectomy probehaving another example user-adjusted cutter port size.

FIGS. 17-19 show example pneumatic circuits for adjusting the size of acutter port of a vitrectomy probe.

FIG. 20 is a schematic view of an example console for use with avitrectomy probe having a user-adjustable cutter port size.

DETAILED DISCLOSURE

The present disclose describes microsurgical instruments including avariable-sized port for removing tissues. Particularly, the presentdisclosure describes ophthalmic vitrectomy probes with auser-selectable, variable-sized port used, for example, in posteriorsegment ophthalmic surgeries. A medical practitioner, such as a surgeon,can control the probe's port size to maximize cutting efficiency andtissue flowability. Alteration of the port size may be accomplished innumerous ways. For example, the port size may be adjusted pneumatically,mechanically, electrically, manually, or by a combination of any ofthese. Some implementations may utilize a mechanical stop to control asize of the port opening. In other implementations, a size of the portopening may be controlled pneumatically. While the examples set outbelow are made with respect to ophthalmic surgical procedures, thedisclosure is not so limited. Rather, the examples provided are merelythat, and the scope of the disclosure may be applicable to any surgicalinstrument for which a variable sized port may be desirable or to whicha variable-sized port may be adapted.

FIG. 1 shows an example surgical console (interchangeably referred to as“console”) 10 within the scope of the present disclosure. The surgicalconsole may be a vitreoretinal surgical console, such as theConstellation® surgical console produced by Alcon Laboratories, Inc.,6201 South Freeway, Fort Worth, Tex. 76134 U.S.A. The console 10 mayinclude one or more ports 20. One or more of the ports 20 may beutilized for providing infusion and/or irrigation fluids to the eye orfor aspirating materials from the eye. The console 10 may also include adisplay 30 for interfacing with the console 10, such as to establish orchange one or more operations of the console 10. In some instances, thedisplay 30 may include a touch-sensitive screen for interacting with theconsole 10 by touching the screen of the display 30. A probe, such as avitrectomy probe may be coupled to a port 20 for dissecting oculartissues and aspirating the ocular tissues from the eye.

FIG. 2 shows an example vitrectomy probe 40. The probe 40 includes acutter 50. As illustrated in FIG. 3, during an ophthalmic surgicalprocedure, such as a retinal surgical procedure, the cutter 50 may beinserted into the posterior segment 60 of the eye 70, such as through acannula 80 disposed in an incision 90 through the sclera 100 of the eye70, to remove and aspirate ocular tissues. For example, during a retinalsurgical procedure, the cutter 50 may be inserted into the posteriorchamber 60 of the eye 70 to remove vitreous humor (interchangeablyreferred to as “vitreous”) 110, a jelly-like substance that occupies thevolume defined by the posterior segment 60. The cutter 50 may also beused to remove membranes covering the retina or other tissues.

FIGS. 4-8 show detailed, cross-sectional views of an example cutter 50with ports 120 adjusted to various sizes. The example cutter 50 mayinclude a hollow outer cutting member 130. The outer cutting member 130in which an opening 115 is formed. The cutter 50 may also include ahollow inner cutting member 140 coaxially arranged within the outercutting member 130 and slideable therein. The inner cutting member 140may also include a cutting edge 150. The cutting edge 150 and theopening 115 may define the port 120. Thus, for example, a position ofthe cutting edge 150 relative to the opening 115 may define the size ofthe port 120. In operation, tissue may enter into the cutter 50 throughthe port 120 and be dissected by the cutting edge 150 as the innercutting member 140 is reciprocated within the outer cutting member 130.The tissue may be dissected by the cutting edge 150 as the inner cuttingmember 140 extends within the outer cutting member 130, closing the port120 (see, e.g., FIG. 8). A vacuum may also be generated within aninterior channel 160 of the cutter 50 to aspirate the dissected tissue.

In some implementations, the inner cutting member 140 is reciprocatedwithin the outer cutting member 130 pneumatically. However, thedisclosure is not so limited. Rather, the cutter 50 may be operated inother ways. For example, the cutter 50 may be operated electrically,hydraulically, or in any number of other ways. Therefore, thedescription of utilizing pneumatics to operate the cutter 50 in one ormore of the implementations is provided merely as an example and is notintended to be limiting.

During an ophthalmic surgical procedure, it may be desirable to change asize of the port 120. For example, a port size may be changed tomaximize cutting efficiency and tissue flowability. Further, a cutterhaving an adjustable port size provides for altering, for example, aduty cycle, cut rate, and port opening independent of each other. FIGS.4-8 illustrate a cutter 50 having port 120 adjusted to different sizes.For example, FIG. 4 shows the size of port 120 adjusted to 100 percent;FIG. 5 shows the size of port 120 at approximately 75 percent; FIG. 6shows the size of port 120 at approximately 50 percent; and FIG. 7 showsthe size of port 120 at approximately 25 percent. FIG. 8 shows the port120 in a closed configuration. While FIGS. 4-8 show port sizes at 75%,50%, 25%, and closed are described, these port sizes are not intended tobe limiting. Rather, it is within the scope of the disclosure that theport size of a probe may be adjusted to any desired size.

In some implementations, the probe may include a piezoelectric linearmotor to alter the port size. FIG. 9 shows a partial cross-sectionalview of an example probe 900. The probe 900 may include a housing 902defining an interior chamber 904, and an oscillator or motor 906. Theouter cutting member 130 may be fixedly coupled to the housing 902. Themotor 906 may include a diaphragm 908 disposed in a pneumatic chamber910. A periphery 940 of the diaphragm 908 may be retained in a groove942 formed in the probe 900. The pneumatic chamber 910 may include afirst passage 912 for communicating a pneumatic pressure to a firstsurface 914 of the diaphragm 908 and a second passage 916 forcommunicating a pneumatic pressure to a second surface 918 of thediaphragm 908. Alternating pneumatic pressure between the first passage912 and the second passage 916 displaces the diaphragm 908 in opposingdirections, causing the diaphragm 908 to oscillate.

The inner cutting member 150 is coupled to the diaphragm 908.Consequently, the inner cutting member 140 is made to oscillate withinthe probe 900 relative to the outer cutting member 130. The innercutting member 140 may be coupled to the diaphragm 106 by a tube 920 anda hollow coupling 922. The inner cutting member 140, the hollow coupling922, and the tube 920 form an interior assembly 924 and define a passage925 that may be utilized for aspirating fluid, tissue, and othermaterial from the eye.

The probe 900 may also include seals 944, 946, 948, and 950. Otherimplementations may include additional, fewer, or different seals thanthose described. The seals 944-950 may be adapted to prevent and/orsubstantially reduce passage of fluid thereby. In some implementations,the seals 944-950 may also provide low resistance to movement of theinterior assembly 924.

The probe 900 may also include a piezoelectric linear motor(interchangeably referred to as “piezoelectric motor”) 926. In someimplementations, the piezoelectric motor 926 may be an ultrasonic linearactuator. The piezoelectric motor 926 may be fixedly secured within thehousing 902. For example, the piezoelectric motor 926 may be securedwithin the housing 902 with a fastener, adhesive, interference fit,retaining clip, or in any other desired manner. In some instances, thepiezoelectric motor 926 may be received into a receptacle formed in thehousing. Power may be provided to the piezoelectric motor 926 via acable 928 extending through the housing 902. In some instances, thepiezoelectric motor 926 may be an SQL-1.8-6 SQUIGGLE® Piezo Linear Motorproduced by New Scale Technologies, Inc., of 121 Victor Heights Parkway,Victor, N.Y. 14564. However, other types of piezoelectric motors may beused and are within the scope of the disclosure.

The piezoelectric motor 926 may include a lead screw 930. Application ofan AC drive voltage signal pair at a first phase offset causes leadscrew 930 to move in the direction indicated by arrow 932. Applicationof an AC drive voltage signal pair at second phase offset different thanthe first phase offset causes lead screw 930 to move in an oppositedirection, corresponding to arrow 934. A moveable member 931 may becoupled to the lead screw 930 and be moveable therewith. Further, aguide 933 coupled to the housing 902 may be included to align themoveable member 931 as the moveable member 931 is moved within thehousing 902. That is, the moveable member 931 may be guided duringmovement by the guide 933. For example, the guide 933 may prevent themember 931 from being becoming misaligned and binding within the probe900.

During operation, a surface 937 of the moveable member 931 may engage alower surface 936 of the coupling 922 to define a fully retractedposition of the inner cutting member 140. As a position of the leadscrew 930 is changed, the position of the moveable member 931 ischanged, and the location at which the moveable member 931 engages thecoupling 922 changes. Consequently, by adjusting a position of the leadscrew 930, the amount of movement of the inner cutting member 140 in thedirection of arrow 934 may be altered, thereby changing the size of theport 120. It is noted that movement of the inner cutting member 140 inthe direction of arrow 934 corresponds to an opening of the port 120shown, for example, in FIGS. 4-8.

While the moveable member 931 is described as engaging the coupling 922,the moveable member 931 may be adapted to engage other parts of theprobe 900. For example, the moveable member 931 may be adapted to engageanother portion of the interior assembly 924 to limit the movement ofthe inner cutting member 140. Still further, in some implementations,the piezoelectric motor 926 may be coupled to the interior assembly 924and the lead screw 930, via the moveable member 931, may engage aportion of the housing 902 to limit a stroke of the inner cutting member140.

In some instances, though, the moveable member 931 and the guide 933 maybe omitted. In such implementations, the lead screw 930 may directlyengage a portion of the interior assembly 924, such as the coupling 922to limit a stroke of the inner cutting member 140. While the probe 900is described above as including a piezoelectric motor 926, any suitablerotational drive motor may be used. For example, in someimplementations, a vitrectomy probe may include a stepper motor or, inother implementations, a DC motor acting against a torsional spring toadjust the port size. These are provided merely as examples. Thus otherrotational drive devices may be utilized to adjust the port size.

FIG. 10 shows another example probe having an adjustable sized portaccording to another implementation. In the example shown in FIG. 10,the construction of probe 1000 may be substantially the same as theconstruction of probe 900 discussed above. However, the construction ofprobes 900 and 1000, as well as the other probes described herein, areprovided merely as examples, and are not intended to be limiting. Thus,probes having constructions other than those examples provided hereinare within the scope of the disclosure.

The probe 1000 may include a housing 1002, an oscillator or motor 1006(which may be similar to the motor 906, described above), and an SMA(“shape memory alloy”) element 1026 rather than a piezoelectric linearmotor. In some instances, the SMA element 1026 may be a NanoMuscle DS-CElinear actuator produced by MIGA Motor Company of 1241 Adams Street#1147, Saint Helena, Calif. 94574. However, this example SMA element isprovided merely as an example. Thus, other types of SMA elements may beused and are, hence, within the scope of the disclosure.

In some implementations, the SMA element 1026 may be coupled to thehousing 1002. For example, the SMA element 1026 may be coupled to thehousing 1002 by being received and retained into a receptacle formed inthe housing 1002. In some instances, the SMA element 1026 may be coupledto the housing, such as with a fastener, an adhesive, a retaining clip,or in any other desired manner.

The SMA element 1026 may include a shaft 1030. In some implementations,the shaft 1030 may be coupled to a moveable member 1031. In someinstances, the probe 1000 may also include a guide 1033. The guide 1033may be coupled to probe 1000, such as to the housing 1002. For example,as illustrated in FIG. 10, the guide rod 1033 may be disposed in a slot1035. A position of the shaft 1030 may be altered by application ofelectrical power to the SMA element 1026, such as via cable 1028. Thepower cable 1128 may be coupled to the console 10, and the console 10may be operable to adjust the electrical power applied to the SMAelement based, for example, on an input to the console 10 by a user.Input from a user to the console 10 may be provided via an input device,such as a touch screen, button, slider, footswitch, or other inputdevice. The implementation of user input described above may be utilizedin the cases of the other example probes described herein.

Application of electrical power to the SMA element 1026 may cause theshaft 1030 and member 1031 to move in the direction of arrow 1032. Themember 1031 may be guided during movement by the guide 1033. Forexample, the guide 1033 may prevent the member 1031 from being becomingmisaligned and binding within the probe 1000. The member 1031 may engagethe coupling 1022, thereby limiting the stroke of inner cutting member140 in the direction of arrow 1034 and defining a fully retractedposition of the inner cutting member 140. As more power is applied tothe SMA element 1026, the shaft 1030 and, correspondingly, the member1031 may extend a greater distance in the direction of arrow 1032.Reduction or elimination of the amount of power applied to the SMAelement 1026 may cause the shaft 1030 and member 1031 to retract andmove in the direction of arrow 1034. Consequently, an extent to whichthe shaft 1030 may be extended or retracted may be controlled by anamount of power applied to the SMA element 1026 and, hence, a locationat which the member 1031 and the coupling 1022 contact each other. Thus,the SMA element 1026 may be utilized as a stroke limiter for the probe1000.

In some instances, though, the moveable member 1031 and the guide 1033may be omitted. In such implementations, the shaft 1030 may directlyengage a portion of the interior assembly 1024, such as the coupling1022 to limit a stroke of the inner cutting member 140.

While the above examples are explained with the shaft 1004 engaging thecoupling 1022, the shaft 1030 and/or moveable member 1031 may be made toengage another portion of the probe 1000 to limit the stroke of theinner cutting member 140.

For example, the shaft 1030 and/or moveable member 1031 may be made toengage another portion of interior assembly 1024, which may include theinner cutting member 140, the hollow coupling 1022, and tube 1020. Instill other implementations, the SMA 1026 may be coupled to the interiorassembly 1024, and the shaft 1030 may be adapted to engage, directly orindirectly, a portion of the probe 1000 that is stationary relative tothe interior assembly 1024. For example, the shaft 1030 may be adaptedto engage a portion of the housing 1002.

FIG. 11A shows a further example probe in which the port size may beadjusted with a fluid-filled cylinder. Example probe 1100 may be similarto the probes 900 and/or 1000, described above in some respects whiledifferent in others. Probe 1100 may include a housing 1102 defining aninterior chamber 1104 and a motor 1106. The probe 1100 may also includea hollow coupling 1122 and a tube 1120 coupled together with the innercutting member 140 to form an interior assembly 1125. The interiorassembly 1125 may be coupled to the motor 1106. The probe 1100 may alsoinclude a stroke limiter 1126 operable to limit the stroke of the innercutting member 140 in the direction of arrow 1134, thereby adjusting thesize of the port 120 (for example, as shown in FIGS. 4-8).

As shown in FIG. 11B, the stroke limiter 1126 may include a push rod1136, a spring 1138, and an enclosure 1140. In some implementations, theenclosure 1140 may be fixed relative to the housing 1102. The push rod1136 may be moveable relative to the enclosure 1140. Further, in someimplementations, the spring 1138 may be omitted.

The enclosure 1140 may include a first portion 1142 housing the spring1138 and a second, fluid-filled portion 1144. In some instances, thefluid-filled portion 1144 may contain a liquid and, in some instances,may be sealed fluid-tight. The push rod 1136 may include a piston 1146and a protrusion 1148. A seal 1147 may be disposed between piston 1146and a wall of the enclosure 1140, for example, to contain fluid in thesecond portion 1144. The protrusion 1148 of the push rod 1136 maycontact the coupling 1122 during opening of the port 120 when the innercutting member 140 moves in the direction of arrow 1134. Consequently,the protrusion 1148 provides a stop, limiting the stroke of the innercutting member 140 during operation of the cutter 50, thereby defining afully retraced position of cutter 140. The push rod 1136 may extendthrough an opening 1149 formed in the enclosure 1140. The first portion1142 and the second portion 1144 may be separated by the piston 1146.

The stroke limiter 1126 may also include a temperature control device1150 operable to change a temperature of a fluid contained within thesecond portion 1144. In some instances, the temperature control device1150 may be a peltier cooler. According to some implementations, thepeltier cooler may be a Pure Precision model 9500/007/018M produced byFerroTec of 33 Constitution Drive, Bedford, N.H. 03110. However, othertypes of peltier coolers may be used. Still further, the disclosure isnot limited to peltier coolers. Rather, any device that produces atemperature differential may be used.

An electrical voltage may be applied to the peltier cooler to generate atemperature difference between a first side 1152 and a second side 1154and, thereby, cause a change in the temperature of the fluid within thesecond portion 1144. The change in temperature of the fluid within thesecond portion 1144 is utilized to change a position of the push rod1136.

Movement of the push rod 1136 in a direction indicated by arrow 1132 maybe accomplished, for example, by applying a voltage to the peltiercooler to heat the fluid contained in the second portion 1144. Theexpanding fluid applies pressure to the piston 1146 and, therefore, aforce on the piston 1146 urging the push rod 1136 to move in a directionof arrow 1132. In implementations including the spring 1138, the spring1138 may apply an opposing force in the direction of arrow 1134. Thepush rod 1136 will move in the direction of arrow 1132 when the forceexerted on the push rod 1136 by the fluid exceeds the biasing force ofthe spring 1138. In implementations containing no spring 1138, the pushrod 1136 moves without influence of a spring force.

Power may be supplied to the stroke limiter 1126 via a power cable 1125.The power cable 1128 may be coupled to a surgical console, such asconsole 10, and the console may be operable to adjust the voltageapplied to the stroke limiter based, for example, on an input to theconsole by a user. Input from a user to the console may be provided viaan input device, such as a touch screen, button, slider, footswitch, orother input device.

The push rod 1136 may be moved in the direction of arrow 1134 bydecreasing or removing the voltage from the peltier cooler and allowingthe fluid within the second portion 1144 to cool or by applying avoltage opposite the voltage to move the push rod 1136 in the directionof arrow 1134. As the fluid cools, the fluid contracts, reducing theforce applied to the push rod 1136, and, therefore, causing the push rod1136 to move in the direction of arrow 1134. Where a spring 1138 ispresent, the force applied by the spring 1138 urges the push rod 1136 inthe direction of arrow 1134. It is noted that inclusion of a spring 1138in the stroke limiter 1126 may provide a higher resolution on positioncontrol of the push rod 1136. That is, the spring 1138 may provide forgreater positional control of the push rod 1136 and, hence, the strokelimiter 1126.

Movement of the push rod 1136 in the direction of arrow 1132 or arrow1134 moves the protrusion 1148 accordingly, causing an increase ordecrease, respectively, in the stroke of the inner cutting member 140.Consequently, the size of the cutter port may be adjusted. Further, insome instances, the rate at which the push rod 1136 moves may becontrolled by a voltage applied to the peltier cooler.

While the illustrated example stroke limiter 1126 utilizes a peltiercooler, other implementations may use any suitable temperature controldevice to adjust a temperature of the fluid contained within secondportion 1146 of the enclosure. For example, temperature control devicessuch as a ceramic resistor.

FIG. 12 shows another example probe that utilizes pressurized gas toadjust a position of a stroke limiter. As shown in FIG. 12, a probe1200, similar to one or more of the probes described above, includes ahousing 1202. The probe 1200 may also include an inner cutting member140, a coupling 1222, and a tube 1220 forming an interior assembly 1225.The interior assembly 1225 may be coupled to a motor 1206 that mayoperate in a manner similar to the motor 906 described above. Forexample, the motor 1206 may include a diaphragm 1208 disposed in a firstchamber 1210. The diaphragm 1208 bisects the first chamber 1210 into afirst chamber portion 1211 and a second chamber portion 1213. A firstpassage 1212 communicates with the first chamber portion 1211, and asecond passage 1216 communicates with the second chamber portion 1213.Pressurized gas may be alternately applied through the first passage1212 and the second passage 1216 to oscillate the diaphragm 1208,thereby oscillating the interior assembly 1225.

The probe 1200 may also include a second chamber 1260 and a strokelimiter 1226. The stroke limiter 1226 may be longitudinally slideable ona surface 1223 of an interior sleeve 1228. In some instances, theinterior sleeve 1228 may have a position fixed relative to the housing1202. The stroke limiter 1226 may be coupled to a housing 1202 of theprobe 1200 via a diaphragm 1227. A peripheral edge 1201 may be disposedin a receptacle 1203 to retain the diaphragm 1227 within the probe 1200.

The diaphragm 1227 bisects the second chamber 1260 to form a firstchamber portion 1262 and a second chamber portion 1264. The diaphragm1227 reacts to pressure differences between the first chamber portion1262 and the second chamber portion 1264 to cause the stroke limiter1226 to move longitudinally relative to the housing 1202 along theinterior sleeve 1228. A spring 1229 may be disposed in the first chamberportion 1262 between the stroke limiter 1226 and a portion of thehousing 1202 or other portion of the probe 1200 stationary relative tothe stroke limiter 122. The spring 1229 provides a biasing force urgingthe stroke limiter 1226 in a direction of arrow 1234.

Further, the interior sleeve 1228 may form a partition between the firstchamber 1210 and the second chamber 1260. A sealing member 1280 may bedisposed between the stroke limiter 1226 and the sleeve 1228 to form aseal. The seal formed by the sealing member 1280 may reduce or preventgas flow into and/or from the second chamber portion 1264. An orifice1265 may extend between the second pneumatic chamber 1264 and anexterior of the probe 1200, providing fluid communication therebetween.An orifice 1209 may be formed between the first chamber portion 1262 andthe exterior of the probe. The orifice 1209 provides for fluid flow intoand out of the first chamber portion 1262 to prevent formation of avacuum in the first chamber portion 1262 and allowing the stroke limiter1226 to move responsive to movement of the diaphragm 1227.

A check valve 1266 may be disposed between a passage 1268 extending fromthe second passage 1216 and the second chamber portion 1264. The checkvalve 1266 may allow pressurized gas to flow into the second chamberportion 1264 from the passage 1268, but not in the opposite direction.Gas contained within the second chamber portion 1264 may be vented tothe environment via the orifice 1265. In some instances, the check valve1266 may biased so as to permit passage of a pressurized gas having aselected pressure while prohibiting passage of a pressurized gas havinga pressure lower than the selected pressure.

In operation, pneumatic pressure is communicated through the passage1268, past the check valve 1266, and into the second chamber portion1264. For example, in some instances, the pneumatic pressure may becommunicated to the second chamber portion 1264 wherein the pneumaticpressure is greater than the selected pressure. Reverse flow isprevented by the check valve 1266. Thus, the pressure of gascommunicated to the second chamber portion 1264 is substantially thesame as the pressure of the gas communicated to the second chamberportion 1213 of the first chamber 1210.

The pneumatic pressure acts on the diaphragm 1227, applying a force onthe stroke limiter 1226 against a biasing force of the spring 1229. Thestroke limiter 1226 may be displaced when the applied force on thestroke limiter 1226 exceeds the biasing force applied by the spring1229. A spring rate of the spring 1229 may be any desired spring rate.For example, the spring rate of spring 1229 may be selected to cause thestroke limiter to displace in the direction of arrow 1232 at a desiredpneumatic pressure.

Pneumatic pressure within the second chamber portion 1264 may be reducedas gas escapes through the orifice 1265. A size of the orifice 1265 maybe selected that the rate at which gas escapes through the orifice 1265from the second chamber portion 1264 is less than the rate at whichpneumatic pressure is supplied to the second chamber portion 1264 aspneumatic pressure is cycled through the second passage 1216. Thus, inoperation, for a given pneumatic pressure, the stoke limiter 1226 may bemaintained at a desired position.

As the pneumatic pressure decreases in the second chamber portion 1264,the spring force from spring 1229 overcomes the force applied by thepneumatic pressure acting on the diaphragm 1227, causing the strokelimiter 1226 to move in the direction of arrow 1234. Therefore, theposition of the stroke limiter 1226 may be adjusted to a desiredposition based on a pressure of the gas. Thus, for a given pneumaticpressure, the stroke limiter 1226 may displace a given amount and remainsubstantially at that position. A higher gas pressure may displace thestroke limiter 1226 a larger amount in the direction of arrow 1232.Similarly, a lower gas pressure may cause the stroke limiter 1226 tomove in the direction of arrow 1234. Thus, the position of the strokelimiter 1226 and, consequently, the size of the cutter port, may becontrolled based on the pressure of the gas.

FIGS. 13 and 14 show a further example probe 1300 and a detail thereof,respectively. The probe 1300 is similar to the probe 1200, describedabove. However, first chamber 1310 is pneumatically isolated from secondchamber 1360.

FIG. 14A is a detail cross-sectional view of example probe 1300 takenalong a different surface passing through probe 1300 than that of thecross-sectional view shown in FIG. 13. For example, the cross-sectionshown in FIG. 14A may be approximately 900 offset from thecross-sectional view shown in FIG. 13. FIG. 14A shows diaphragm 1306disposed in the first chamber 1310 and diaphragm 1327 disposed in thesecond chamber 1360. Spring 1329 is also shown in first chamber portion1362, and an orifice 1309 is formed between the first chamber portion1362 and an exterior of the probe 1300 to provide fluid communicationtherebetween. A passage 1370 is in fluid communication with the secondchamber portion 1364. Pneumatic pressure may be introduced into andreleased from the second chamber portion 1364 via a passage 1370. Thus,pneumatic pressure may be applied to the diaphragm 1327 via passage 1370to position stroke limiter 1326 at a desired location. Further,pneumatic pressure applied to the second chamber portion 1364 toposition stroke limiter 1326 may be applied independently of thepneumatic pressure utilized to operate motor 1306.

A pneumatic pressure corresponding to a desired cutter port size may beintroduced into and maintained in the second chamber portion 1364 tomaintain a desired position of the stroke limiter 1326. Similar to probe1200, the spring 1329 may provide a bias force on the stroke limiter1326. The pneumatic pressure applied to the second chamber portion 1364may be altered when a change in position of the stroke limiter 1326 isdesired. For example, the applied pneumatic pressure may be increased toreduce the cutter port size, for example, by moving stroke limiter 1326closer to coupling 1322. Alternately, the applied pneumatic pressure maybe decreased to increase the cutter port size, for example, by movingthe stroke limiter 1326 away from the coupling 1322. Still further, insome instances, no pneumatic pressure may be applied to the secondchamber portion 1364, providing for the port to open a maximum amount.

FIG. 14B shows a cross-section of a probe 1400 similar to thecross-section shown in FIG. 14A. However, unlike the probe 1300 shown inFIG. 14A, chamber pneumatic pressure may be supplied to first chamberportion 1462 via passage 1480 to act as a bias element. Thus, probe 1400may not include a spring in the second chamber portion 1464. Pneumaticpressure supplied to the first chamber portion 1462 may be altered tocontrol a size of port 120 of the probe 1400. For example, the pneumaticpressures supplied to first chamber portion 1462 via conduit 1480 and1464 via conduit 1470 may be selected to control the port size of thecutter 1400. For example, the magnitude of the pneumatic pressuresupplied to the first chamber portion 1462 may be selected to control anamount of resistance experienced by diaphragm 1327 in response topneumatic pressure supplied to second chamber portion 1464. In stillother instances, the conduit 1480 may be eliminated and a selectedpressure may be introduced into and retained within the first chamberportion 1462.

FIG. 15 shows another example vitrectomy probe 1500. Probe 1500 may besimilar in operation to one or more of the probes described above. Forexample, probe 1500 may include a housing 1502, an inner cutting member140, coupling 1522, and a tube 1520 that, combined, form an interiorassembly 1524. The interior assembly 1524 may be coupled to a diaphragm1508 disposed in a chamber 1510. Alternating Application of pneumaticpressure to opposing sides of the diaphragm 1508 causes the diaphragm1508 and interior assembly 1524 to oscillate.

The probe 1500 may also include a stroke limiter 1526. The strokelimiter 1526 includes a threaded surface 1550. The stroke limiter 1526is threadably retained in an interior sleeve 1528. The interior sleeve1528 includes an inner threaded surface 1552 that cooperatively engagesthe threaded surface 1550 of the stroke limiter 1526. The stroke limiter1526 may also include a geared surface 1554. The geared surface 1554 mayinclude a plurality of gear teeth 1556 extending in a direction parallelto a longitudinal axis 1558 of the stroke limiter 1526. A thumb screw1560 rotatably coupled to the housing 1502 by a shaft 1562 may include ageared surface 1564 having a plurality of gear teeth 1566 also extendingin a direction parallel to the longitudinal axis 1558. The plurality ofgear teeth 1556 intermesh with the plurality of gear teeth 1564 suchthat, when the thumb screw 1560 is rotated, the stroke limiter 1526 iscorresponding rotated, causing the stroke limiter 1526 to raise or lowerrelative to the interior sleeve 1528 as a result of the cooperativelyengaging threaded surfaces 1550 and 1552. The stroke limiter 1526 andthe thumb screw 1560 are configured to slide longitudinally relative toeach other because of the longitudinal orientation of the intermeshinggear teeth 1556, 1566.

Consequently, a user of the probe 1500, such as a surgeon, may adjust aport size of the probe's cutter by rotating the thumb screw 1560 aboutshaft 1562. As explained, rotating the thumb screw 1562 in one of afirst or second direction about the shaft 1562 causes the stroke limiter1526 to one of move in a direction parallel to arrow 1532 or in adirection parallel to arrow 1534. Movement of the stroke limiter 1526 ina direction of the arrow 1532 moves the stroke limiter 1526 closer tothe coupling 1522, thereby reducing the port size opening. Alternately,moving the stroke limiter 1526 in the direction of arrow 1534 increasesthe port size opening.

FIG. 16 shows another example variable port size vitrectomy probe 1600.Probe 1600 is similar to one or more of the probes described above inthat the probe 1600 includes an outer cutting member 130, an innercutting member 140 moveable within and relative to the outer cuttingmember 130. The inner cutting member 130 is coupled to coupling 1622 andtube 1620, which forms an interior assembly 1625. The tube 1620 iscoupled to diaphragm 1608 fixedly coupled to housing 1602 about aperiphery 1640. The diaphragm 1608 is disposed within pneumatic chamber1610. Thus, as described above, as pneumatic pressure is alternatelyapplied through passages 1612 and 1616 to opposite sides of thediaphragm 1608, the diaphragm and the interior assembly 1625 oscillate,resulting in the opening and closing of the cutter port.

Probe 1600 may be used with any one of the example pneumatic circuitsshown in FIGS. 17-19 that are utilized to control the cutting port sizeduring operation of the probe 1600. FIG. 17 shows an example pneumaticcircuit 1700. The pneumatic circuit 1700 may include pneumatic lines1702, 1704, 1706, 1708 and 1710. An isolation valve 1712 may be disposedbetween pneumatic lines 1702 and 1704 and is fluidly coupledrespectively thereto. An output valve 1714 is fluidly coupled to each ofpneumatic lines 1704, 1706, 1708, and 1710. A venting control valve 1716is also fluidly coupled to pneumatic line 1706. A muffler 1718 may alsobe fluidly coupled to the venting control valve 1716, and a muffler 1720may be fluidly coupled to the isolation valve 1712.

Isolation valve 1712, output valve 1714, and venting control valve 1716may be solenoid-operated valves. For example, each of valves 1712, 1714,and 1716 may include a solenoid 1722. Each of the valves 1712, 1714, and1716 may also include a return spring 1724. Referring to the isolationvalve 1712 as an example, in a rest position (shown in FIG. 17), theisolation valve 1712 fluidly communicates the pneumatic line 1704 withthe muffler 1720. Consequently, in such a configuration, pneumaticpressure present in pneumatic line 1704 is vented to the atmosphere viathe muffler 1720. A biasing force from return spring 1724 may bias theisolation valve 1712 in the direction of arrow 1726. Upon actuation, thesolenoid 1722 moves the isolation valve 1712 in the direction of arrow1728 and into an actuated position, compressing return spring 1724 andcausing the pneumatic line 1702 to fluidly communicate with pneumaticline 1704. The pneumatic line 1702 may be a pneumatic supply linecontaining compressed gas. When the isolation valve 1712 is in theactuated position, the compressed gas in the pneumatic line 1702 iscommunicated through the isolation valve and into pneumatic line 1704.When actuation of the solenoid 1722 is ceased, the return spring 1724returns the valve 1712 to the rest position. Output valve 1714 andventing control valve 1716 may operate in a similar manner.

In some instances, a pressure sensor 1726 may be included in pneumaticline 1708 to sense a pneumatic pressure therein. Similarly, a pressuresensor 1728 may be included in pneumatic line 1710 to sense a pneumaticpressure therein. For example, in some instances, if one or both of thepressure sensor 1726, 1728 sense a pressure outside of a selectedpressure range, the pressure sensor 1726 and/or 1728 may send a signalto the console, for example, to implement a corrective action, indicatea warning to a user, cease one or more operations of the console (e.g.,operation of the probe), or perform some other activity. Connectors 1730and 1732 may be attached at ends of pneumatic lines 1708 and 1712,respectively. A vitrectomy probe, such as probe 1600, may be coupled tothe connectors 1730 and 1732, such as by flexible tubing, so thatpassage 1612 is in fluidly communication with pneumatic line 1708 andpassage 1616 is in fluid communication with pneumatic line 1710. Inother implementations, these connections may be reversed.

In operation, the isolation valve 1712 may be actuated into the actuatedposition, thereby supplying compressed gas from the pneumatic line 1702to the pneumatic line 1704. When the output valve 1714 is in the restposition, the pneumatic line 1704 is in communication with pneumaticline 1708, and the pneumatic line 1710 is in communication withpneumatic line 1706. Consequently, compressed gas from the pneumaticline 1704 is conducted through the output valve 1714 to the pneumaticline 1708. The compressed gas is, thus, communicated to the probe 1600through passage 1612 and displaces the diaphragm 1608 in the directionof arrow 1634. That is, the inner cutting member 140 is retracted. Also,while the output valve 1714 is in the rest position, pneumatic pressurein the pneumatic line 1710 is allowed to pass through the output valve1714, through pneumatic line 1706, through venting control valve 1716(when in the rest position), and out to the environment through themuffler 1718.

When the solenoid 1722 of the output valve 1714 is actuated, the outputvalve 1714 moves into the actuated position, providing fluidcommunication between the pneumatic line 1704 and the pneumatic line1710. Compressed gas is thus communicated through the pneumatic line1710 and through passage 1616 of the probe 1600. The compressed gasimpinges on the diaphragm 1608, causing the diaphragm 1608 to move inthe direction of arrow 1632. Thus, the inner cutting member 140 is movedinto the extended position. Also, pneumatic pressure in the pneumaticline 1708 is released and allowed to pass through output valve 1714,through pneumatic line 1706, through venting control valve 1722 and outto the environment through muffler 1718.

The output valve 1714 may be reciprocated to alternately supplypressurized gas to one of the pneumatic lines 1708, 1710 while releasingpneumatic pressure in the other of the pneumatic lines 1708, 1710. As aresult, pneumatic pressure is alternately supplied to opposing sides ofthe diaphragm 1608 to cause the diaphragm 1608 and inner cutting member140 to reciprocate. Thus, the cutter of the probe 1600 is made tooperate. The output valve 1714 may be rapidly oscillated to cause theinner cutting member 140 of the probe 1600 to rapidly reciprocate.

The venting control valve 1716 may be operated to control a port size ofthe cutter of the probe 1600 by, for example, interrupting exhaust ofpressurized gas from the passage 1616. For example, as described above,the inner cutting member 140 is retracted and the port of the cutter(see, e.g., FIGS. 4-8) is opened when the output valve 1714 is in therest position, allowing pressurized gas to pass through pneumatic line1708 and passage 1612 to cause the diaphragm to deflect and innercutting member to retract in the direction of arrow 1634. At the sametime, gas is allowed to pass out of the passage 1616, though pneumaticline 1710 and, ultimately, out to the environment through the ventingcontrol valve 1716 and muffler 1718. However, during a part of the timethe pressurized gas is allowed to escape from passage 1616, the ventingcontrol valve 1716 may be moved to the actuated position, stoppingrelease of the pressurized gas into the environment and, thereby,creating backpressure in the passage 1616. The generated backpressureprevents or substantially reduced further movement of the diaphragm 1608in the direction of arrow 1634. Consequently, the amount by which theinner cutting member 140 is retracted is reduced, and, correspondingly,the port size of the cutter is reduced.

As shown in FIG. 17, a proportional valve 1734 may be used in place ofthe venting control valve 1716 to control a cutter port size. Ratherthan providing a merely an open or closed condition, the proportionalvalve 1734 provides an open condition that is variable. That is, theproportional valve 1734 may have a variable-sized conduit to adjust afluid flow rate passing through the valve. For example, in someinstances, the proportional valve 1734 may be a needle valve that may beplaced in a closed position, preventing fluid flow, or opened to variousdegrees corresponding to differing fluid flow rates. Consequently, byusing a proportional valve, the exhaust flow rate can be controlled. Theuse of a proportional valve may provide for greater control over theexhaust port size rate of change and a smooth pressure transition, asopposed to an abrupt change.

The port size of the probe's cutter may be controlled by, for example,controlling when the venting control valve 1716 is moved into theactuated position, thereby generating backpressure against movement ofthe diaphragm 1608. For example, the earlier the venting control valve1716 is moved into the actuated position to generate pressure withinpassage 1616, the smaller the resulting cutter port size. On the otherhand, the later the venting control valve 1716 is moved to the actuatedposition, the larger the resulting cutter port size.

Similar to the other example probes described herein, the size of thecutter opening may be adjusted by input from a user. For example, theuser, such as a surgeon, may provide input to control the cutter sizethrough an input device, such as a touch screen, a button, a knob, aslider, a footswitch, or other input device. An example footswitch mayhave a pivotable member actuatable by the user's foot over an angularrange. As articulation of the pedal is increased, the port size of thecutter may be reduced accordingly.

FIG. 18 shows another example pneumatic circuit 1800 that may be used tocontrol a cutter port size of a vitrectomy probe, such as probe 1600.The pneumatic circuit 1800 may include pneumatic lines 1802, 1804, and1806 as well as a manifold 1808. Isolation valves 1810, 1812, and 1814may also be included. The isolation valves 1810, 1812, and 1814 may besimilar to the isolation valve 1712, described above. For example, eachof the isolation valves 1810, 1812, and 1814 may include a solenoidactuator 1811 and a return spring 1813. Isolation valve 1810 may befluidly coupled to the pneumatic line 1802 and manifold 1808. Isolationvalve 1812 may be fluidly coupled to the pneumatic line 1804 andmanifold 1808, and isolation valve 1814 may be fluidly coupled to thepneumatic line 1806 and manifold 1808. Mufflers 1816, 1818, and 1820 maybe fluidly coupled to isolation valve 1810, output valve 1812, andoutput valve 1814, respectively. Further, pressure sensors 1822 and 1824may be included in pneumatic lines 1804 and 1806, respectively. Thepressure sensors 1822, 1824 may be similar to the pressure sensors 1726,1728. Further, output provided by sensors may be utilized in wayssimilar to those described above with respect to sensors 1726, 1728.Also, the pneumatic circuit 1800 may also include connectors 1826 and1828 to which a probe, such as probe 1600, may be coupled. For example,probe 1600 may be coupled to the connectors 1826, 1828 such that passage1612 is in fluid communication with pneumatic line 1804 and the passage1616 is in fluid communication with pneumatic line 1806.

In the rest position, the isolation valve 1810 provides fluidcommunication between the pneumatic line 1802 and the manifold 1808.Thus, with the isolation valve 1810 in the rest position, pressurizedgas in the pneumatic line 1802 is communicated into the manifold 1808.In the actuated position, the manifold 1808 is placed in fluidcommunication with muffler 1816, and any pressurized gas in the manifold1808 is released into the atmosphere via the muffler 1816.

In the rest position, isolation valves 1812, 1814 provide fluidcommunication between the pneumatic lines 1804, 1806 to the environmentvia mufflers 1818, 1820, respectively. In the actuated position,pressurized gas in the manifold 1808 is communicated to the respectivepneumatic lines 1804, 1806. Thus, in operation, the cutter of probe 1600may be actuated by positioning one of the isolation valves 1812 and 1814in the rest position and the other of the isolation valves 1812 and 1814in the actuated position. For example, the isolation valve 1812 may bepositioned in the actuated position to supply pressurized gas to thediaphragm 1608, and the isolation valve 1814 may be positioned in therest position to allow pressurized gas to escape from the passage 1616.Consequently, the diaphragm 1608 and inner cutting member 140 may bemoved in the direction of arrow 1634. The positions of each isolationvalve 1812, 1814 may be reversed to move the inner cutting member 140 inthe opposite direction.

As also shown in FIG. 18, a proportional valve 1834, similar to theproportional valve 1734, may be used in place of one or more of theisolation valves 1812, 1814. The proportional valve 1834 may function ina similar way as the isolation valve 1734, thereby providing controlover the exhaust flow rate. Consequently, the use of a proportionalvalve may provide for greater control over the exhaust port size rate ofchange and a smooth pressure transition.

The cutter port size may be controlled, for example, by controlling thetime at which the isolation valve 1814 is moved from the rest position(i.e., passage 1616 open to atmosphere) to the actuated position (i.e.,passage 1616 exposed to pneumatic pressure of manifold 1808) while theisolation valve 1812 is in the actuated position (i.e., passage 1612exposed to pneumatic pressure of manifold 1808). When the isolationvalve 1812 is in the actuated position and the isolation valve 1814 isin the rest position, pressurized gas is supplied from pneumatic line1804 to the passage 1612 to move the diaphragm 1608 in the direction ofarrow 1634 and pressurized gas from the passage 1616 vented to theatmosphere through pneumatic line 1806.

In other implementations, the cutter port size may be controlled bycontrolling an amount of time the isolation valve 1812 is placed in theactuated position and the isolation valve 1814 is placed in the restposition. For example, the amount of time the isolation valve 1812 is inthe actuated position simultaneously with the isolation valve 1814 beingin the rest position may be used to control the opening size of theport. Particularly, in some instances, the isolation valve 1812 may bemoved into the actuated position along with the isolation valve 1814being moved into the rest position for a shorter period of time incomparison to the isolation valve 1814 being in the actuated positionand the isolation valve 1812 being in the rest position. Further, theamount of time the isolation valve 1812 is in the actuated position withthe isolation valve 1814 in the rest position may be altered to controlthe port size. For example, a longer period of time in thisconfiguration may result in a larger port size, while a short timeperiod may result in a smaller port size.

In still other implementations, a manually controlled one-way restrictorvale may be placed in the pneumatic circuit, for example, betweenconnector 1828 and the passage 1616. FIG. 19 shows an example system1900 for operating the vitrectomy probe 1600. A vitrectomy probe, suchas the vitrectomy probe 1600, is fluidly coupled to a console 1904. Insome instances, the console 1904 a Constellation console and may includea controller for use in operating the vitrectomy probe 1600. A firstpneumatic line 1906 and a second pneumatic line 1908 may extend betweenthe vitrectomy probe 1600 and the console 1904. The pneumatic lines1906, 1908 may be utilized to carry compressed gas to a motor foroperating the motor 1606 of the vitrectomy probe 1600 and the cuttercoupled thereto. In some instances, the pneumatic line 1906 may carrycompressed gas to actuate the inner cutting member 140 so as to closethe cutter port, and the pneumatic line 1908 may carry compressed gas toactuate the inner cutting member 140 so as to open the cutter port.

An aspiration line 1910 may also extend between the vitrectomy probe1902 and the console 1904. The aspiration line 1910 may be utilized totransport materials, e.g., fluids and dissected tissues, from the probe1902 to the console 1904. A one-way restrictor 1912 may be disposed inthe pneumatic line 1906. The one-way restrictor 1912 may be operable toallow the passage of pressurized gas in a first direction 1914 withlittle to no resistance while providing a greater amount of resistanceto flow of the pressurized gas in a second direction 1914 opposite thefirst direction 1902. In some instances, the amount of resistanceprovided by the one-way restrictor 1900 may be adjusted to control theport size. For example, a greater amount of resistance may result in asmaller port size, while a decreased amount of resistance may result ina larger port size. The amount of resistance to flow provided by theone-way restrictor 1912 may be adjusted manually, such as by a user ofthe probe 1600, or may be adjusted by interacting with the console 1904.For example, a user may manipulate a control of the console 1904 toadjust the restriction to air flow provided by the one-way restrictor1912.

FIG. 20 shows a schematic view of an example console 2000 that may beused with one or more of the vitrectomy probes described herein.Consoles 10 and/or 1904 may be similar to the console 2000 describedherein. An example vitrectomy probe 2016 is shown coupled to the console2000. The console 2000 may be used to provide power to the probe 2016.In some instances, the power provided by the console 2000 may bepneumatic power. In other instances, the power may be electrical power.In still other instances, the power may be hydraulic power. However, instill other instances, the console 2000 may provide any suitable powerto the probe 2016 for operation thereof. The console 2000 may also beoperable to monitor and/or control other aspects of a surgical procedurefor which the console 2000 may be used. For example, the console 2000may be operable to control an infusion rate of fluid to a surgical site,aspiration of fluid from the surgical site, as well as to monitor one ormore patient vital signs.

The console 2000 may include a processor 2002, memory 2004, and one ormore applications, including vitrectomy probe application 2006. Theconsole 2000 may also include one or more input devices 2008, and one ormore output devices, such as a display 2010. The display 2010 maydisplay a graphical user interface or application interface(collectively referred to as “GUI 2012”), discussed in more detailbelow. A user may interface with the GUI 2012 to interact with one ormore features of the console 2000. The one or more input devices 2008may include a keypad, a touch screen, a mouse, a foot-operated inputdevice (e.g., a footswitch), or any other desired input device.

Additionally, the console 2000 may include an operations portion 2014.In some instances, the operations portion 2014 may include a powersource for a vitrectomy probe, aspiration components, as well as one ormore sensors, pumps, valves and/or other components for operating avitrectomy probe 2016. The vitrectomy probe 2016 may be coupled to theoperations portion 2014 of the console 2000 via an interface panel 2018.

Memory 2004 may include any memory or module and may take the form ofvolatile or non-volatile memory including, without limitation, magneticmedia, optical media, random access memory (RAM), read-only memory(ROM), removable media, or any other suitable local or remote memorycomponent. Memory 2004 may contain, among other items, the vitrectomyprobe application 2006. The vitrectomy probe application 2006 mayprovide instructions for operating aspects of the vitrectomy probe 2016,such as the port size in the probe's 2016 cutter, cutter speed, dutycycle, cutter pulsing configuration, etc.

Memory 2004 may also store classes, frameworks, applications, backupdata, jobs, or other information that includes any parameters,variables, algorithms, instructions, rules, or references thereto.Memory 2004 may also include other types of data, such as environmentand/or application description data, application data for one or moreapplications, as well as data involving virtual private network (VPN)applications or services, firewall policies, a security or access log,print or other reporting files, HyperText Markup Language (HTML) filesor templates, related or unrelated software applications or sub-systems,and others. Consequently, memory 2004 may also be considered arepository of data, such as a local data repository from one or moreapplications, such as vitrectomy probe application 2006. Memory 2004 mayalso include data that can be utilized by one or more applications, suchas the vitrectomy probe application 2006.

Application 2006 may include a program or group of programs containinginstructions operable to utilize received data, such as in one or morealgorithms, to determine a result or output. The determined results maybe used to affect an aspect of the system 2000. The application 2006 mayinclude instructions for controlling aspects of the vitrectomy probe2016. For example, the application 2006 may include instructions forcontrolling a port size of the cutter of the vitrectomy probe 2016. Forexample, the application 2006 may determine one or more adjustments tothe operations portion 2014. The adjustments may be implemented by oneor more transmitted control signals to one or more components of console2000, such as the operations portion 2014. While an example console 2000is shown, other implementations of the console 2000 may include more,fewer, or different components than those shown.

Processor 2002 executes instructions and manipulates data to perform theoperations of the console 2000, e.g., computational and logicoperations, and may be, for example, a central processing unit (CPU), ablade, an application specific integrated circuit (ASIC), or afield-programmable gate array (FPGA). Although FIG. 20 illustrates asingle processor 2002 in console 2000, multiple processors 2002 may beused according to particular needs and reference to processor 2002 ismeant to include multiple processors 2002 where applicable. For example,the processor 2002 may be adapted for receiving data from variouscomponents of the console 2000 and/or devices coupled thereto, processthe received data, and transmit data to one or more of the components ofthe system 2000 and/or devices coupled thereto in response. In theillustrated embodiment, processor 2002 executes vitrectomy probeapplication 2006.

Further, the processor 2002 may transmit control signals to or receivesignals from one or more components coupled thereto. For example, theprocessor 2002 may transmit control signals in response to receiveddata. In some implementations, for example, the processor 2002 mayexecute the application 2006 and transmit control signals to theoperations portion 2014 in response thereto.

The display 2010 displays information to a user, such as a medicalpractitioner. In some instances, the display 2010 may be a monitor forvisually displaying information. In some instances, the display 2010 mayoperate both as a display and an input device. For example, the display2010 may be a touch sensitive display in which a touch by a user orother contact with the display produces an input to the console 2000.The display 2010 may present information to the user via the GUI 2012.

GUI 2012 may include a graphical user interface operable to allow theuser, such as a medical practitioner, to interface with the console 2000for any suitable purpose, such as viewing application or other systeminformation. For example, GUI 2012 could provide information associatedwith a medical procedure, including detailed information related to avitreoretinal surgical procedure and/or operational aspects of thevitrectomy probe 2016.

Generally, GUI 2012 may provide a particular user with an efficient anduser-friendly presentation of information received by, provided by, orcommunicated within console 2000. GUI 2012 may include a plurality ofcustomizable frames or views having interactive fields, pull-down lists,and buttons operated by the user. GUI 2012 may also present a pluralityof portals or dashboards. For example, GUI 2012 may display an interfacethat allows users to input and define parameters associated with thevitrectomy probe 2016. It should be understood that the term graphicaluser interface may be used in the singular or in the plural to describeone or more graphical user interfaces and each of the displays of aparticular graphical user interface. Indeed, reference to GUI 2012 mayindicate a reference to the front-end or a component of application 2006without departing from the scope of this disclosure. Therefore, GUI 2012contemplates any graphical user interface. For example, in someinstances, the GUI 2012 may include a generic web browser for inputtingdata and efficiently present the results to a user. In other instances,the GUI 2012 may include a custom or customizable interface fordisplaying and/or interacting with the various features of theapplication 2006 or other system services.

In some implementations, the console 2000 may be in communication withone or more local or remote computers, such as computer 2022, over anetwork 2024. Network 2024 facilitates wireless or wirelinecommunication between console 2000 and, generally, console 2000 and anyother local or remote computer, such as computer 2022. For example,medical practitioners may use the computer 2022 to interact withconfigurations, settings, and/or other aspects associated with operationof the system 200, including the services associated with theapplication 2006. Network 2024 may be all or a portion of an enterpriseor secured network. In another example, network 2024 may be a VPN merelybetween console 2000 and computer 2022 across wireline or wireless link.Such an example wireless link may be via 802.11a, 802.11b, 802.11g,802.20, WiMax, ZigBee, Ultra-Wideband and many others. While illustratedas a single or continuous network, network 2024 may be logically dividedinto various sub-nets or virtual networks without departing from thescope of this disclosure, so long as at least a portion of network 2024may facilitate communications among console 2000, computer 2022, andother devices.

For example, console 2000 may be communicably coupled to a repository2026 through one sub-net while communicably coupled to computer 2022through another. In other words, network 2024 encompasses any internalor external network, networks, sub-network, or combination thereofoperable to facilitate communications between various computingcomponents. Network 2024 may communicate, for example, Internet Protocol(IP) packets, Frame Relay frames, Asynchronous Transfer Mode (ATM)cells, voice, video, data, and other suitable information betweennetwork addresses (collectively or interchangeably referred to as“information”). Network 2024 may include one or more local area networks(LANs), radio access networks (RANs), metropolitan area networks (MANs),wide area networks (WANs), all or a portion of the global computernetwork known as the Internet, and/or any other communication system orsystems at one or more locations. In certain embodiments, network 2024may be a secure network accessible to users via certain local or remotecomputer 2022.

Computer 2022 may be any computing device operable to connect orcommunicate with console 2000 or network 2024 using any communicationlink. In some instances, computer 2022 may include an electroniccomputing device operable to receive, transmit, process, and store anyappropriate data associated with console 2000. Computer 2022 may alsoinclude or execute a GUI 2028. GUI 2028 may similar to GUI 2012. It willbe understood that there may be any number of computers 2022communicably coupled to console 2000. Moreover, for ease ofillustration, computer 2022 is described in terms of being used by oneuser. But this disclosure contemplates that many users may use onecomputer or that one user may use multiple computers.

As used in this disclosure, computer 2022 is intended to encompass apersonal computer, touch screen terminal, workstation, network computer,kiosk, wireless data port, smart phone, personal data assistant (PDA),one or more processors within these or other devices, or any othersuitable processing device. For example, computer 2022 may be a PDAoperable to wirelessly connect with an external or unsecured network. Inanother example, computer 2022 may be a laptop computer that includes aninput device, such as a keypad, touch screen, mouse, or other devicethat can accept information, and an output device that conveysinformation associated with the operation of console 2000 or computer2022, including digital data, visual information, or user interface,such as GUI 2028. Both input devices and output devices may includefixed or removable storage media such as a magnetic computer disk,CD-ROM, or other suitable media to both receive input from and provideoutput to users of computer 2022 through, for example, a display.

As explained above, application 2006 may include instructions forcontrolling aspects of the vitrectomy probe 2016. Example aspects mayinclude cutter speed, cutter port size, cutter duty cycle, as well asothers. Thus, the console 2000 may be operable to control the port sizeof the example vitrectomy probe 2016. In controlling the vitrectomy portsize, a user may indicate a desired port opening size with an input viaan input device. For example, the cutter port size may be adjusted viathe input device 2008.

In instances in which the vitrectomy probe 2016 includes a piezoelectricmotor, such as a piezoelectric motor similar to the piezoelectric motor926 described above, a user may adjust the cutter port size via theinput device 2008. In response, the console may output a signal to thepiezoelectric motor to effect the desired port size. For example, if anincreased port size is indicated, the console 2000 may output an ACcurrent to alter a position of a lead screw thereof to increase the portsize. If a decreased port size is indicated, the console 2000 may outputan AC current to alter the lead screw position to decrease the portsize.

In some instances, the application 2006 may include instructions forcontrolling the port size of a vitrectomy probe with an SMA element,which may be similar to SMA element 1026. Accordingly, a user input toadjust the port size of vitrectomy probe 2016 may cause the controller2000 to output electrical power to cause the SMA element to adjust theport size to the desired level. For example, in some exampleimplementations, when an increased port size is desired, the console2000 may decrease or stop output of electrical power to the SMA elementto cause an increased port size. Alternately, if a decreased port sizeis desired, the console 2000 may increase electrical power to decreasethe port size.

In other instances, the vitrectomy probe 2016 may include a strokelimiter similar to the stroke limiter 1126, described above.Accordingly, when a user indicates a change in port size, e.g., via aninput device, the controller 2000 may output or alter an output of powerto cause the stroke limiter to alter the port size accordingly. Forexample, where a port size change is indicated, the console 2000 mayadjust an electrical voltage to the stroke limiter to adjust the portsize accordingly.

In other instances where example vitrectomy probe 2016 is similar tovitrectomy probe 1200, the console 2000 may alter port size, forexample, by altering a pneumatic pressure supplied to the probe 2016.For example, where a decreased port size is indicated by the user, theconsole 2000 may increase a pneumatic pressure supplied to the probe2016. Alternately, where an increased port size is indicated, theconsole 2000 may respond by decreasing a pneumatic pressure supplied tothe probe 2016.

In instances in which the vitrectomy probe 2016 is similar to probe1300, the port size may also be adjusted by altering a pneumaticpressure supplied to a pneumatic chamber similar to second chamber 1360.Where a decreased port size is indicated, the console 2000 may increasea pneumatic pressure supplied to the pneumatic chamber. Where anincreased port size is indicated, a decreased pneumatic pressure may besupplied to the pneumatic chamber.

For a vitrectomy probe similar to vitrectomy probe 1600, the console mayadjust the port size such as by operating the pneumatic circuits 1700,1800, and 1900 as described in detail above.

While examples are provided above, they are provided merely as examplesand are not intended to limit the scope of the present disclosure.

In some implementations, the input device 2008 may be a footswitchcoupled to the console 2000, such as via a wired or wireless connection.A surgeon may adjust the port size by manipulating a control on thefootswitch. For example, the footswitch may include a pedal pivotablewithin a range, and the surgeon may adjust the port size by actuatingthe pedal within the range. The footswitch may also include othercontrols, such as one or more buttons, for example, to adjust a cuttingrate (e.g., the rate at which the inner cutting member 130 isreciprocated), an aspiration rate (e.g., an amount of suction appliedthrough the vitrectomy probe), and a duty cycle. Any of these aspects ofthe vitrectomy probe may be altered independently of the others.

It should be understood that, although many aspects have been describedherein, some implementations may include all of the features, whileothers may include some features while omitting others. That is, variousimplementations may include one, some, or all of the features describedherein.

A number of implementations have been described. Nevertheless, it willbe understood that various modifications may be made without departingfrom the spirit and scope of the disclosure. Accordingly, otherimplementations are within the scope of the following claims.

What is claimed is:
 1. A system for performing a vitrectomy comprising:a vitrectomy probe comprising: a first inlet port operable to conductpneumatic pressure to an oscillator, a second inlet port operable toconduct pneumatic pressure to the oscillator, and a cutter comprising afirst portion and a second portion, the oscillator operable toreciprocate the first portion relative to the second portion, an amountof movement of the first portion relative to the second portion defininga port size of the cutter; a control system comprising: an output valve;a first output port operable to provide communication between the firstinlet port of the vitrectomy probe and the output valve; a second outputport operable to provide communication between the second inlet port ofthe vitrectomy probe and the output valve; a first conduit coupled tothe output valve and operable to provide communication with the outputvalve; a venting control valve; a second conduit extending between theoutput valve and the venting control valve operable to conduct pneumaticpressure from the output valve to the venting control valve; a firstoutlet coupled to the venting control valve and open to the atmosphere,the venting control valve operable to selectively vent pneumaticpressure from the second conduit to the atmosphere; and a controlleroperable to: oscillate the output valve between a first position inwhich pneumatic pressure is communicated from the first conduit to thefirst output port and pneumatic pressure is communicated from the secondoutput port to the second conduit, and a second position in whichpneumatic pressure is communicated from the first conduit to the secondoutput port and pneumatic pressure is communicated from the first outputport to the second conduit, the output valve maintained at the firstposition and the second position for a selected time period; and movethe venting control valve between a first position in which a firstamount of pneumatic pressure from the second conduit is vented to theatmosphere through the first outlet and a second position in which asecond amount of pneumatic pressure is vented to the atmosphere throughthe first outlet, the controller operable to maintain the exhaustcontrol valve at the first position for a first period of time less thanthe selected period of time when the output valve is in the secondposition and move the exhaust control valve from the first position tothe second position after the first period of time has elapsed to definethe port size of the vitrectomy probe.
 2. The system of claim 1, whereinthe first amount of pneumatic pressure is greater than the second amountof pneumatic pressure.
 3. The control system of claim 1, wherein theventing control valve is an on/off valve, wherein the first position ofthe venting control valve is a fully open position, and wherein thesecond position of the venting control valve is a fully closed position.4. The control system of claim 1, wherein the venting control valve is aproportional valve, wherein the first amount of pneumatic pressurevented to the atmosphere comprises a first variable amount ofcommunication, and wherein the second amount of communication betweenthe second conduit and the second outlet when the venting control valveis in the second position comprises a second variable amount ofcommunication between the second conduit and the second outlet, thefirst variable amount of communication being different than the secondvariable amount of communication.
 5. The control system of claim 4,wherein the first variable amount of communication is greater than thesecond variable amount of communication.
 6. The system of claim 1,wherein the control system further comprises: an isolation valve, thefirst conduit extending between the isolation valve and the outputvalve; an inlet conduit coupled to the isolation valve and operable tocommunicate pneumatic pressure to the isolation valve, a second outletcoupled to the isolation valve and open to the atmosphere; wherein thecontroller is further operable to move the isolation valve between afirst position in which the inlet conduit is in communication with thesecond outlet to vent pneumatic pressure in the first outlet conduit tothe atmosphere and a second position in which the inlet conduit is incommunication with the first conduit to conduct pneumatic pressure tothe output valve.
 7. The system of claim 1, wherein the control systemfurther comprises: a first pressure sensor coupled to the first outputport; and a second pressure sensor coupled to the second output port,wherein controller is operable to: receive a first signal from the firstpressure sensor corresponding to pneumatic pressure at the first outputport and a second signal from the second pressure sensor correspondingto pneumatic pressure at the second output port; and move the isolationvalve to the first position if the first pressure signal or the secondpressure signal is outside of a selected range.